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Online Student Application

Two easy steps to register
By entering and submitting the form, I am requesting academic accommodations or other services as an individual with disability; as defined by Federal law. Accommodations and services are provided in accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990; as respectively amended.

I also acknowledge that the Family Educational Rights and Privacy Act of 1974 (FERPA) allows Harper College to disclose certain information about me. Access & Disability Services (ADS) staff, as officials of the College, can disclose information without my consent for legitimate educational purposes. ADS staff will attempt to limit the sharing of disability-related information about me when possible, but will share pertinent information on my behalf when it relates to my educational goals and/or accommodations.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Hint: Enter 9 alpha numeric characters.
  3. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only (i.e. enter 5417377000 for 541 737 7000).
  2. Hint: Enter 10-digit number only (i.e. enter 5417377000 for 541 737 7000).
Local Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Questions
  1. Disability Information (Select all that apply):
  2. Have you applied for financial aid?*
  3. How does your disability affect your reading?*
  4. How does your disability affect your spelling?*
  5. How does your disability affect your writing?*
  6. How does your disability affect your math?*
  7. How does your disability affect your understanding of vocabulary?*
  8. How does your disability affect your memory?*
  9. How does your disability affect your attention/concentration?*
  10. How does your disability affect your study habits? (taking notes, studying for exams, etc.)*
  11. How does your disability affect your time management/organization?*
  12. How does your disability affect your understanding of lectures?*
  13. How does your disability affect your ability to take notes?*
  14. How does your disability affect your self control?*
  15. How does your disability affect your ability to interact with others?*
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